Transforming and Supporting Patient Care - Health Professions ...

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224Chapter 10 – Profession of Midwiferywomen during pregnancy, labour and the post-partum period and of theirnewborn babies, the provision of care during normal pregnancy, labour andpost-partum period and the conducting of spontaneous normal vaginaldeliveries.” 2Midwives provide antepartum, intrapartum and postpartum care, that is,care before, during and after childbirth, in hospitals, maternity centres andin the woman’s home. 3 In 2007–2008, midwives provided care toapproximately 12,500 women in Ontario. 4Since 1994, midwives have obtained admitting privileges at two-thirds ofOntario hospitals that provide maternity care. Approximately 78 percent ofmidwifery clients choose to give birth in the hospital setting, while 22percent opt for home births. About 1.5 percent of all babies in Ontario areborn at home. Given demographic and other social trends affectingmaternity care, the total number of births that take place in hospitals isexpected to rise. Ontario’s experience in home births is comparable to thatof Great Britain, where the rate of births taking place in the home is aroundtwo percent. In 2006–2007, 366 midwives provided care for eight percent ofthe 134,141 births in Ontario. 5Midwifery is a managed government program in Ontario. Midwives areconsidered primary care providers and a referral from another healthprofessional is not required. They can provide autonomous prenatal,intrapartum and postpartum care.The Ontario Ministry of Health and Long-Term Care allocates an annualbudget for midwifery services, education and placements in the province.Midwives work as independent practitioners in group practices that arefunded by the Ministry’s Ontario Midwifery Program (OMP). Each practicegroup has a funding arrangement with a Ministry-approved non-profitagency (transfer payment agency) that receives funding from the OMP anddistributes it to midwifery practice groups. Each midwifery practice group,usually comprised of two to five midwives, then has a funding agreementwith the transfer payment agency to provide services in a particulargeographic area. 62Midwifery Act, 1991, S.O. 1991, c.31, s. 3.3HPRAC. An Interim Report to the Minister of Health and Long-Term Care on Mechanisms to Facilitateand Support Interprofessional Collaboration Among Health Colleges and Regulated HealthProfessionals: Phase II, Part 1. September 2008: 82.4College of Midwives of Ontario. Annual Report 2007-2008. 7.5HPRAC. Review of the Scope of Practice of Midwifery, An Interim Report to the Minister of Health andLong-Term Care on Mechanisms to Facilitate and Support Interprofessional Collaboration AmongHealth Colleges and Regulated Health Professionals: Phase II, Part 1. 85.6Ibid.HPRAC Critical Links January 2009
225Chapter 10 – Profession of MidwiferyHow the CMO Regulates its MembersThe CMO is the regulatory body for the province’s 414 registered midwives(RMs). 7 The CMO’s primary responsibility is the protection of the public,specifically childbearing women and their infants, to whom its membersprovide care. 8Legislative and Regulatory Framework for the Practice of MidwiferyThe Midwifery Act, 1991 regulates the practice of midwifery in Ontario. Inaddition, midwives’ scope of practice is defined through regulations, CMOguidelines and standards of practice as well as other legislation. One of theCMO’s key standards for midwifery practice is Indications for MandatoryDiscussion, Consultation and Transfer of Care (Indications).This documentprovides a guide for midwives on when they are required to discuss,consult or transfer primary care responsibility for the patient to anotherhealth professional. 9Authorized ActsUnder the Midwifery Act, 1991, midwives are authorized, in the course ofengaging in the practice of midwifery, subject to the terms, conditions andlimitations imposed on his or her certificate of registration, to perform thefollowing:Regulations1. Managing labour and conducting spontaneous normal vaginaldeliveries;2. Performing episiotomies and amniotomies and repairingepisiotomies and lacerations, not involving the anus, analsphincter, rectum, urethra and periurethral area;3. Administering, by injection or inhalation, a substance designatedin the regulations;4. Putting an instrument, hand or finger beyond the labia majoraduring pregnancy, labour and the postpartum period;5. Taking blood samples from newborns by skin pricking or fromwomen from veins or by skin pricking;6. Inserting urinary catheters into women;7. Prescribing drugs designated in the regulations. 10The Council may make regulations, subject to the review of the Minister andapproval of the Lieutenant Governor in Council as follows:(a) designating the substances that may be administered byinjection or inhalation by members in the course of engaging inthe practice of midwifery;(b) designating the drugs that may be prescribed by members in the7CMO. Annual Report 2007-2008. 7.8CMO. Mandate. Available : http://www.cmo.on.ca/aboutMandate.asp.9An Interim Report to the Minister of Health and Long-Term Care on Mechanisms to Facilitate andSupport Interprofessional Collaboration among Health Colleges and Regulated Health Professionals:Phase II, Part 1: 91.10MA, c.31, s. 4.HPRAC Critical Links January 2009
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20Chapter 2 - Excellence in Health
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56Chapter 3 - A New Drug Approvals
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88Chapter 4 - Critical Links: Propo
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164Chapter 7 - Professions of Chiro
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274Chapter 12 - Profession of Nursi
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310Chapter 13 - Profession of Optom
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340Chapter 14 - Profession of Pharm
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366Chapter 15 - Profession of Physi
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378Chapter 16 - Profession of Respi
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394Chapter 17 - Conclusionscontinui
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396Chapter 17 - Conclusionsincluded
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398Chapter 18 - Summary of Proposal
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